The problem of the milk supply in the smaller cities is quite different from that of our larger cities. In the smaller cities, even those with populations of one hundred thousand, there may be commonly found a number of milkmen who bring into the city the milk from their own farms and personally distribute it. Such a business is a small one, and the dealer and the producer may be held directly responsible for the quality of the milk. In large cities, however, the business is very different. The individual milk dealer who brings in milk from his own farm has almost disappeared, and his place is supplied by the milk-supply companies that control the product from hundreds of farms and regulate the large part of the milk which the city consumes. These companies send milk trains into the country in all directions, and collect milk from thousands of farms. The milk is brought into the city in cars in which it is cooled by ice. It may be already many hours old when it reaches the city. It is taken from the cars, and the milk from many different sources is mixed in large mixers to insure greater uniformity. It is again packed in ice, and remains thus until the individual dealer is ready to put it into his cart and distribute it through the city to the customer.
As a result of this the customer no longer knows whence his milk comes. If he is a citizen of New York, he may receive milk from his own State, or Connecticut, or Pennsylvania, or New Jersey. It may come from a thrifty farmer, or from a slovenly, filthy farm, or, for all that the consumer knows, it may come in part from a farm where there is a contagious epidemic. There is no method of tracing responsibility, no method of even knowing the source of any lot of milk. One morning we may receive milk from northern New York, and the next from New Jersey. One morning, for all he knows, it may come from a model dairy farm, and the next from the most unhygienic surroundings imaginable.
But this is to a certain extent true of other foods. We can not tell where our flour or meat comes from, or our apples or sugar. Why should we be more disturbed over milk than other foods? Indeed, until recently we have had no especial interest in the milk problem, and have taken milk as it has been offered without question, except as to its being pure milk unadulterated with water. But the rapid discoveries of bacteriology, which have shown milk to be such a good locality for bacterial growth, have been raising some very significant questions. We have been told of the countless millions of bacteria which we have been drinking daily. This has somewhat disturbed us, and no sooner have we become reconciled to this idea than we are told of the great amount of filth that finds its way into milk—two hundred pounds of cow dung being the daily ration of New York city, some one tells us. The matter appears more serious still when we are told by the public press that there are more bacteria in city milk than in city sewage, and are informed of the epidemics of typhoid which are distributed by milk, or of the prevalence of tubercle bacteria in this food product. We become suspicious of the milk supply and hesitate to use this food product or to give it to our children.
Naturally, the people in small communities feel somewhat more at ease in the matter since they know their milk producer and can hold him responsible. But it is questionable whether the milk supply of the large city is not more reliable. The milk supply in the city is handled by organizations, and these, on the whole, are rather more likely to exercise care in the treatment of the milk than are the small dealers. The advantage of handling the matter through companies is well shown in many European cities. In the large cities of England and the continent the milk business is commonly handled by concerns that distribute great quantities daily. Now, many of these companies deal with the subject in a very intelligent manner. They exercise a very considerable control over the individual dairy farms. Some of them keep inspectors traveling constantly among the farms, spending $10,000 to $15,000 yearly in such inspections. They will receive no milk from a farm until after an inspector has visited it and looked into the hygienic conditions of the dairy, even sometimes going so far as to make an analysis of the water used in the dairy. Only after such inspection has been declared favorable is the milk received in the city. These inspections are repeated monthly. The appearance of a contagious disease on the farm is noted at once and the milk no longer received, although still paid for. These companies employ chemists and bacteriologists to study the character of the milk received. They educate their men into their business, and consequently employ more intelligent help than small concerns can. They can furnish a more uniform product than can be expected of smaller dealers. They soon acquire a reputation for their milk, which they are very careful to preserve. Such firms can exercise a much more satisfactory control over the individual farmer than can even public statute, since, with their systems of inspection, it is possible to have an accurate knowledge of the actual conditions under which the milk is produced. It is plainly within the power of firms dealing in large quantities to control the character of its milk more accurately than can small dealers.
Results, too, appear on the whole in favor of the large dealers. In the cities where there is a system of rigid milk inspection it is comparatively seldom that the milk furnished by such companies is found below the standard. This milk is kept up to the standard, and the companies having a chemical laboratory and having milk from many sources can keep the quality of the milk much more uniform than can a dealer whose supply comes from a single farm. The milk inspectors usually find that it is the small dealers that fail to meet the standard. Moreover, it is a fact that where epidemics have been traced to milk it has always been in communities where individual milkmen bring in milk from one or two dairies and distribute it personally. All the epidemics of typhoid that have been definitely traced to milk have been in small communities, and none traced to the milk of large dealers. It is true that it would be difficult or impossible to trace to the milk a typhoid epidemic which might occur in a large city. No one is likely to receive the milk from the same source for two days in succession, and the mixing which the milk receives in the receiving station entirely obliterates the individual source. If there should be some milk brought to the city which contained typhoid bacteria it would be impossible to determine the fact, for such milk, after mixing, would be thoroughly scattered beyond any possibility of following it. We may, then, question somewhat the significance of the fact, but it certainly is true that while serious epidemics have been caused by milk in smaller cities no such instance has occurred in the large cities, or been traced to the milk furnished by companies that handle it in considerable amounts. It would seem that if milk has ever been the cause of such diseases in large cities there ought to have been some evidence of the fact obtained.
It is probable, therefore, that the small community can hardly feel itself any better off in regard to the milk supply than the larger city. It is, of course, easier to trace responsibility for bad milk if we know where it comes from, but it is less likely to be very bad if it comes from a large number of sources and is thoroughly mixed. The milk in the large city is perhaps forty-eight hours old when it is received by the consumer. But it has been kept on ice, has perhaps been filtered, and many of its bacteria may have been killed by the long-continued cold temperature. So far as concerns the bacteria question, our milk which is thus two days old, appears to be actually superior to milk delivered in European cities, which is only a few hours old. The free use of ice in our milk car produces a more favorable result than the more rapid handling which the milk receives in Europe. The milk company controlling a large territory, with great resources at its command, can put into practice rules which even public statute can not enforce, and which the individual farmer will rarely do by himself. One who is acquainted with the methods of handling milk in our cities finds that the companies are each year improving their methods, and that the milk is in most places becoming more reliable. The proper solution of the milk supply for our communities is in the formation of large companies, provided they are managed partly for the benefit of the public and not wholly for money-making.
There is little question that the public has become somewhat suspicious of milk, and that many hesitate to drink it as freely as in earlier years. This suspicion is more pronounced in Europe than in the United States. Upon the continent of Europe the amount of milk which is used raw is really very small, and apparently its use in this condition is destined to cease. The younger generation of physicians are now being taught that raw milk is a dangerous food, and in some countries even the children in the schools are being taught that it is not safe to drink raw milk. Such teaching can have only one result, and that is the reduction in the amount of milk consumed. Much less milk is used in Europe than in this country. It is used for tea or coffee or for cooking, and of course for infant feeding, but for any one to drink milk as we do in this country is certainly a rarity. The suspicion under which milk has been placed has decreased its use.
The dangers which are feared in milk are of course connected with the distribution of disease. Most persons who thus hesitate to use milk have simply a vague fear, without knowing just what is to be feared. When we put together all the facts in our possession we find that there is good reason for believing that milk is sometimes concerned in the distribution of the following well-known diseases and some obscure ones: The first is tuberculosis, which is a disease attacking the cow, and, if located in the mammary gland, may infect the milk with tubercle bacilli, and may subsequently produce the disease in the person who drinks the milk. It should be stated, however, that there is good reason for believing that the danger from this source has been overrated. Second, we have diphtheria, which apparently may also attack the cow. The diphtheria germs may get into the milk from the cow, and they certainly do get into the milk occasionally from secondary sources. Scarlet fever apparently is distributed by milk, though whether this disease may come from the cow or only by secondary contamination of the milk is not yet positively settled. Typhoid fever has in a large number of cases been traced to the milk supply. This disease, however, does not occur in the cow, and the germs always get into the milk from a secondary source, such as water or contact with a person who has the disease. Cholera may be distributed by milk, but this is of course of little importance. Of these disease bacteria, the tubercle bacillus probably never grows in milk, while the typhoid and diphtheria germs do. The most common of all troubles attributed to milk are those somewhat obscure intestinal diseases which attack people especially in the summer months, and are particularly common among children. Prominent among these stands cholera infantum. These latter troubles, according to our present knowledge, are not produced by distinct species of bacteria finding entrance into the body and growing there, as are the other diseases mentioned. They appear to be produced by bacterial poisons which are in the milk. The bacteria—probably several different varieties—grow in the milk and there give rise to certain poisonous products, and these, when taken into the stomach, produce the diarrhœal diseases referred to.
The question of more importance is, however, as to the extent of the danger from such causes. This question is much like the famous one of how large is a piece of chalk. There is danger in everything, even in drinking water and breathing air. Is the danger from milk so great as to suggest that we should give up our habit of drinking milk as they have largely done in Europe, or is this danger so slight that we can well afford to neglect it? We can not avoid all sources of disease even if we would. To do this we should need to shut ourselves up in a box, breathe nothing but sterilized air, drink nothing but sterilized water, and come in contact with no other person, to say nothing of wearing sterilized clothes. Such a method will produce physical weakness rather than vigor. We have learned in the last few years that the proper way of avoiding disease is rather by preparing ourselves to resist it rather than try to avoid all contact with possible disease germs. The question is significant, then, whether the danger from milk is so great that we should use every means of avoiding it; or is it one of the slight dangers which we may best class with the everyday incidents against which our proper guard should be simply vigorous health?
It is impossible to say how great is the liability of contracting disease from milk. Sometimes the subject looms up before us in gigantic proportions. When our papers are describing the occurrence of hundreds of cases of typhoid fever in a city, all traced to a milk supply, the seriousness of the problem is very apparent, and very likely we stop drinking milk for a season. But when, on the other hand, we remember the millions of people that are drinking milk daily without injury, and remember that our forefathers have done the same, we grow graver and begin again our old custom. No one can, indeed, pretend to say how great the danger is. That it is greater than that from drinking water is pretty clear. That it is less than that of riding in the cars is probably equally true. That it is greater in a small community than a large one seems probable, and that there is a greater likelihood of its being serious where the milk comes from a single source than where it passes through the hands of a milk-supply company appears to the author to be quite sure.